Nonsurgical Treatments Research Articles

Active trachoma: enhancing image classification using pretrained SOTA models and explainable AI

BackgroundTrachoma, an infectious disease that leads to blindness, continues to pose a significant public health challenge in over 40 countries as of 2023. The initial phase of this disease, “active trachoma” is characterized by inflammation and can be effectively treated with non-surgical interventions. However, if left untreated, it progresses to the “scarring” phase, often requiring surgical intervention. Earlier detection of “active trachoma” is critical to prevent unnecessary surgery and also to reduce the transmission of the infection. Developing accessible tools for a region with limited resources is necessary. Deep neural networks have proven their effectiveness in numerous image and vision-related tasks, yet research on “active trachoma” has received still little attention.MethodIn this study, we adapted several pre-trained state-of-the-art deep neural network models like ResNet, Xception from image classification on “active classification” task. Further experiments were also conducted in three cases: training from scratch, training from pretrained models on raw images and on region-of-interest (ROI) focused images.Results and discussionThe results indicate that these models outperformed the previous studies using the same dataset, achieving an improvement of 6\% on detection of follicular trachomatous inflammation and 12\% for detection of intense trachomatous inflammation. Furthermore, we employed the eXplainable Artificial Intelligence tool Grad-CAM, which revealed a significant discrepancy between eyelid's geometric centroid and attention centroid from models with high classification accuracy. This finding suggests that the conventional method of selecting a region of interest based on the geometric centroid may need to be adjusted. Using XAI can offer valuable insights into understanding the classification and progression of active trachoma.

Applications and effects of «Cold Atmospheric Plasma» in Aesthetics

Aging is an unavoidable and natural process for all organs. The aging process of the face is a gradual atrophic progression of soft and hard tissues and takes place gradually, over 3 to 4 decades, with a little clinical evidence. It is eventually recognized by the emergence of furrows and wrinkles together with a loss of tonicity. The consequences of this on the patient’s self-confidence could negatively influence the quality of life in a psychological and social way. Different techniques have been used for removing or improving the signs of ageing. Currently, a physicochemical approach, based on ionized gases, is joining the skin non-surgical treatments. This technology, named Cold Atmospheric Plasma (CAP), was already used in dermatology to promote wound healing. Today, CAP is entering into the cosmetic field, thus providing a new challenge. In reason of their unique ability to generate a complex chemical mix and thanks to their physical properties, CAPs could be a promising alternative in non-invasive treatment of skin. However, the scientific bases of cold plasma effects on skin and the identification of their exact mechanisms of action, both at the cellular and at the molecular levels, are still lacking and they constitute a new active field of investigation. The present article is a literature review of the applications and effects of «cold atmospheric plasma» in aesthetics.

Remarkable response as a new indicator for endoscopic evaluation of local efficacy of non-surgical treatments for esophageal cancer.

In Japan, standard of care of the patients with resectable esophageal cancer is neoadjuvant chemotherapy (NAC) followed by esophagectomy. Patients unfitted for surgery or with unresectable locally advanced esophageal cancer are generally indicated with definitive chemoradiotherapy (CRT). Local disease control is undoubtful important for the management of patients with esophageal cancer, therefore endoscopic evaluation of local efficacy after non-surgical treatments must be essential. The significant shrink of primary site after NAC has been reported as a good indicator of pathological good response as well as favorable survival outcome after esophagectomy. And patients who could achieve remarkable shrink to T1 level after CRT had favorable outcomes with salvage surgery and could be good candidates for salvage endoscopic treatments. Based on these data, "Japanese Classification of Esophageal Cancer, 12th edition" defined the new endoscopic criteria "remarkable response (RR)", that means significant volume reduction after treatment, with the subjective endoscopic evaluation are proposed. In addition, the finding of local recurrence (LR) at primary site after achieving a CR was also proposed in the latest edition of Japanese Classification of Esophageal Cancer. The findings of LR are also important for detecting candidates for salvage endoscopic treatments at an early timing during surveillance after CRT. The endoscopic evaluation would encourage us to make concrete decisions for further treatment indications, therefore physicians treating patients with esophageal cancer should be well-acquainted with each finding.

Spinal cord hemangioblastomas in von Hippel-Lindau disease.

von Hippel-Lindau disease (VHL) is an autosomal dominant familial neoplasia syndrome. The most common manifestation of VHL is central nervous system hemangioblastomas. VHL patients will often develop multiple hemangioblastomas along their craniospinal axis over their lifetime. Spinal cord hemangioblastomas account for nearly half of all nervous system hemangioblastomas in VHL. The authors conducted a literature review and summation of available articles on spinal cord hemangioblastomas associated with VHL. The embryological origins, epidemiology, natural history, surgical outcomes, nonsurgical treatments, and future directions in spinal cord hemangioblastomas are discussed. Hemangioblastomas in VHL are optimally managed with a multidisciplinary approach that includes surgical resection of symptomatic lesions. Novel treatments are gaining traction, but must be studied further for efficacy and safety.

Periocular sebaceous carcinoma: updates in the diagnosis, treatment, staging, and management.

Periocular sebaceous carcinoma (PSC) is a rare, aggressive, and potentially metastatic adnexal malignancy. Due to the ability of PSC to resemble several benign and malignant conditions, diagnosis is often delayed or mistaken. In addition, even with a known diagnosis, choosing the right treatment is still an open debate. For this reason, we decided to review the most up-to-date literature on PSC and propose a dedicated procedural protocol to help clinicians when dealing with PSC. A PubMed search was carried out using the terms "Sebaceous Carcinoma", "Adnexal Periocular Cancer", "Sebaceous Carcinoma AND eyelid", "Periocular Sebaceous Carcinoma", and "Ocular Adnexa". Pertinent studies published in English from 1997 up to December 2022 were compared to the selection criteria and if suitable, included in this review. Through the initial search, 84 articles were selected. Of these, 36 were included in the final study. Several papers explored different diagnostic and therapeutic strategies regarding PSC diagnosis and management. In light of the current literature review and the multidisciplinary experience of three clinical centers, a dedicated procedural protocol is proposed. PSC diagnosis may be achieved through accurate clinical evaluation, but it requires histopathologic confirmation, which can be challenging. Dermoscopy, in vivo reflectance confocal microscopy, and optical coherence tomography may facilitate PSC clinical examination, while immunohistochemistry stains may support histological diagnosis. Appropriate disease staging is necessary before choosing the treatment, as local disease requires radically different treatment compared to advanced disease. In addition, recent innovations in nonsurgical treatments, including radio-chemotherapy, immunotherapy, and targeted therapy, may be a viable option in the most challenging cases.

Cost-Effectiveness of Gene-Specific Prevention Strategies for Ovarian and Breast Cancer

Pathogenic variants (PVs) in BRCA1, BRCA2, PALB2, RAD51C, RAD51D, and BRIP1 cancer susceptibility genes (CSGs) confer an increased ovarian cancer (OC) risk, with BRCA1, BRCA2, PALB2, RAD51C, and RAD51D PVs also conferring an elevated breast cancer (BC) risk. Risk-reducing surgery, medical prevention, and BC surveillance offer the opportunity to prevent cancers and deaths, but their cost-effectiveness for individual CSGs remains poorly addressed. To estimate the cost-effectiveness of prevention strategies for OC and BC among individuals carrying PVs in the previously listed CSGs. In this economic evaluation, a decision-analytic Markov model evaluated the cost-effectiveness of risk-reducing salpingo-oophorectomy (RRSO) and, where relevant, risk-reducing mastectomy (RRM) compared with nonsurgical interventions (including BC surveillance and medical prevention for increased BC risk) from December 1, 2022, to August 31, 2023. The analysis took a UK payer perspective with a lifetime horizon. The simulated cohort consisted of women aged 30 years who carried BRCA1, BRCA2, PALB2, RAD51C, RAD51D, or BRIP1 PVs. Appropriate sensitivity and scenario analyses were performed. CSG-specific interventions, including RRSO at age 35 to 50 years with or without BC surveillance and medical prevention (ie, tamoxifen or anastrozole) from age 30 or 40 years, RRM at age 30 to 40 years, both RRSO and RRM, BC surveillance and medical prevention, or no intervention. The incremental cost-effectiveness ratio (ICER) was calculated as incremental cost per quality-adjusted life-year (QALY) gained. OC and BC cases and deaths were estimated. In the simulated cohort of women aged 30 years with no cancer, undergoing both RRSO and RRM was most cost-effective for individuals carrying BRCA1 (RRM at age 30 years; RRSO at age 35 years), BRCA2 (RRM at age 35 years; RRSO at age 40 years), and PALB2 (RRM at age 40 years; RRSO at age 45 years) PVs. The corresponding ICERs were -£1942/QALY (-$2680/QALY), -£89/QALY (-$123/QALY), and £2381/QALY ($3286/QALY), respectively. RRSO at age 45 years was cost-effective for RAD51C, RAD51D, and BRIP1 PV carriers compared with nonsurgical strategies. The corresponding ICERs were £962/QALY ($1328/QALY), £771/QALY ($1064/QALY), and £2355/QALY ($3250/QALY), respectively. The most cost-effective preventive strategy per 1000 PV carriers could prevent 923 OC and BC cases and 302 deaths among those carrying BRCA1; 686 OC and BC cases and 170 deaths for BRCA2; 464 OC and BC cases and 130 deaths for PALB2; 102 OC cases and 64 deaths for RAD51C; 118 OC cases and 76 deaths for RAD51D; and 55 OC cases and 37 deaths for BRIP1. Probabilistic sensitivity analysis indicated both RRSO and RRM were most cost-effective in 96.5%, 89.2%, and 84.8% of simulations for BRCA1, BRCA2, and PALB2 PVs, respectively, while RRSO was cost-effective in approximately 100% of simulations for RAD51C, RAD51D, and BRIP1 PVs. In this cost-effectiveness study, RRSO with or without RRM at varying optimal ages was cost-effective compared with nonsurgical strategies for individuals who carried BRCA1, BRCA2, PALB2, RAD51C, RAD51D, or BRIP1 PVs. These findings support personalizing risk-reducing surgery and guideline recommendations for individual CSG-specific OC and BC risk management.

Surgical and non-surgical interventions for primary and salvage treatment of growth hormone-secreting pituitary adenomas in adults.

Surgical and non-surgical interventions for primary and salvage treatment of growth hormone-secreting pituitary adenomas in adults.

The effect of the COVID-19 lockdown on women presenting with pelvic organ prolapse.

To determine whether there is a difference in pelvic organ prolapse (POP) stage at time of presentation after lifting coronavirus disease (COVID-19) lockdown restrictions, as compared to before the lockdown. Enhancing our understanding of how healthcare utilization for pelvic floor disorders may be affected by limited accessibility, such as the COVID-19 pandemic, could prove invaluable for similar future circumstances. This is a retrospective study of women with POP at their initial visit. Patients were grouped into two cohorts based on their initial presentation time: pre-COVID-19 lockdown (before March 2020) and post-COVID-19 lockdown (after December 2020). The cohorts were compared using demographic, clinical, and surgical variables. A logistic regression controlling for confounders was used to evaluate the influence of the COVID-19 lockdown on prolapse stage. There were 656 (50.3%) patients in the pre-COVID-19 lockdown cohort and 648 (49.7%) in the post-COVID-19 lockdown cohort. All baseline characteristics were similar between both cohorts except for race (p = 0.015). Treatment choices differed with the post-COVID-19 lockdown cohort having a lower proportion (26.5%) opting for surgery and a higher proportion (50.5%) of patients opting for nonsurgical interventions compared to the pre-COVID-19 lockdown cohort (p = 0.0005). A higher proportion of women presented with stages I and II prolapse in the post-COVID-19 lockdown (70.4%) cohort as compared to the pre-COVID-19 lockdown (62.5%) cohort (p = 0.002). Women in the post-COVID-19 lockdown cohort presented with early stage prolapse with preference for more conservative treatment options.

(192) Tunical Incision and Grafting for Severe Peyronie’s Disease Using Human Fascia Lata: Surgical Technique

Abstract Introduction Management of Peyronie’s disease is challenging for patients and can present with deformed penile angulation, pain, and reduction in erectile function. This video demonstrates the usage of cadaveric fascia lata grafting to rectify severe ventral penile curvature symptomatic of advanced Peyronie’s disease. Objective We outline a surgical technique to use fascia lata allografting for the correction of excessive ventral penile curvature caused by Peyronie’s disease if non-surgical treatments are insufficient. Methods A 65 year-old African-American male patient with severe Peyronie’s disease and a history of hypertension presented with a ventral penile curvature of 110 degrees at the proximal third of the shaft. Consequently, he was unable to engage in penetrative sexual intercourse. An artificial hydraulic erection confirmed the curvature, and the areas of fibrotic plaque were palpated. A degloving incision was made proximal to the glans, and a 6 cm segment of Buck’s fascia was elevated ventrally. The neurovascular bundle and urethra were separated from the corporae. A second hydraulic erection was induced, exposing a 6 cm by 3.5 cm rectangular tunical defect which was marked for excision. Bovie electrocautery was utilized to excise the fibrotic section of tunica albuginea. A rectangular section of Biosure human cadaveric fascia lata graft was soaked in saline solution and trimmed to 6 cm by 4 cm. The graft was sutured to the excised region of the tunica albuginea with 4-0 Maxon in a watertight fashion with a running stitch. A final hydraulic erection confirmed the mitigation of the penile curvature, and Buck’s fascia and the shaft skin were re-approximated to the subcoronal skin with 3-0 Vycril suture. Results This grafting procedure resulted in a near complete resolution of the ventral penile curvature with no complications. The patient was admitted overnight for observation and discharged POD 1 with a 3-layer dressing and mesh underwear. The postoperative penile length increased to 17.5cm from 16cm preoperatively as a result of the grafting and mitigation of the penile curvature. Conclusions Fascia lata allografts are robust and easily obtainable, which is ideal for the corporal reconstruction of fibrotic tunica albuginea in patients with Peyronie’s disease. This procedure demonstrates the utility of cadaveric fascia lata as an alternative surgical grafting material for the surgical correction of penile curvature associated with severe Peyronie’s disease. Disclosure No.

Cost-Effectiveness Analyses of Non-Pharmacological and Non-Surgical Interventions in Idiopathic Parkinson's Disease: A Systematic Review.

Interest in non-pharmacological/non-surgical interventions to treat Parkinson's disease (PD) has substantially increased. Although a few health-economic studies have been conducted, summary information on the cost-effectiveness is still scarce. To give an overview of cost-effectiveness analyses (CEA) focusing on non-pharmacological/non-surgical interventions in PD patients. A systematic literature search was conducted in five databases. Studies were included that provided cost-effectiveness analysis (CEA) or cost-utility analysis (CUA) of non-pharmacological/non-surgical interventions in PD patients. Study quality was assessed with the Drummond and CHEERS 2022 checklists, respectively for economic evaluation. N = 9 studies published between 2012-2023 were identified. Most studies undertook a CUA (n = 5); n = 3 reported a combination of CEA and CUA, and n = 1 a pure CEA. Most studies (n = 6) examined physical exercise. The CEA studies identified additional costs of 170€ -660€ for the improvement of one single unit of a clinical outcome and savings of 18.40€ -22.80€ per score gained as measured with established instruments. The four studies that found significant quality of life benefits show large variations in the incremental cost effectiveness ratio (ICER) of 3,220€ -214,226€ per quality-adjusted life year (QALY); notably interventions were heterogenous regarding content and intensity. Despite increasing numbers of non-pharmacological/non-surgical intervention trials in PD patients, health-economic evaluations are rare. The examined intervention types and health-economic results vary greatly. Together with the heterogeneity of the health-economic studies these factors limit the conclusions that can be drawn. Further research and a standardization of methods is needed to allow decision makers to make meaningful interpretations, and to allocate scarce resources.

Intraplaque injections of hyaluronic acid for the treatment of stable-phase Peyronie's disease: a retrospective single-center experience.

Peyronie's disease (PD) is a condition of penile connective tissue affecting up to 10% of men worldwide. In the complexity of its management, nonsurgical treatments, such as intraplaque injections, are gaining attention. The current literature shows data on the efficacy of intraplaque injections of hyaluronic acid (HA) mainly in acute-phase PD. However, data on injections of HA in stable-phase PD are lacking. Data for this retrospective study were derived from a prospectively maintained database of private patients presenting at a private medical practice affiliated to the University of Naples "Federico II" (Naples, Italy) with stable-phase PD between January 2020 and March 2023. Patients underwent a standard protocol of three injections, each administered at a two-week interval. During the intervals, patients performed vacuum device therapy, penile stretching, and modeling exercises. All patients compiled the Peyronie's Disease Questionnaire (PDQ) and Global Assessment of Peyronie's Disease (GAPD) at baseline and 2 weeks after the third injection. A penile Doppler ultrasound was performed 2 weeks after the last injection to record the final curvature. Overall, we recruited 62 patients with stable-phase PD and a mean (±standard deviation [s.d.]) curvature of 52.7° (±9.7°). After 6 weeks, eight (12.9%) patients did not experience any curvature improvement. The remaining 54 patients had a final mean (±s.d.) curvature of 40.3° (±9.1°) with P < 0.001, compared to that before treatment. We found improvement in all PDQ domains (all P ≤ 0.01), and 50 (80.6%) patients reported subjective improvement of the penile curvature according to the GAPD. In conclusion, we demonstrated that after three injections of HA administered according to the adopted protocol, patients with stable-phase PD could experience significant improvements in penile curvature, and physical and psychological consequences of the disease without significantly relevant side effects.

Minimal clinically important change of knee flexion in people with knee osteoarthritis after non-surgical interventions using a meta-analytical approach

BackgroundMinimal clinically important change (MCIC) represents the minimum patient-perceived improvement in an outcome after treatment, in an individual or within a group over time. This study aimed to determine MCIC of knee flexion in people with knee OA after non-surgical interventions using a meta-analytical approach.MethodsFour databases (MEDLINE, Cochrane, Web of Science and CINAHL) were searched for studies of randomised clinical trials of non-surgical interventions with intervention duration of ≤ 3 months that reported change in (Δ) (mean change between baseline and immediately after the intervention) knee flexion with Δ pain or Δ function measured using tools that have established MCIC values. The risk of bias in the included studies was assessed using version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). Bayesian meta-analytic models were used to determine relationships between Δ flexion with Δ pain and Δ function after non-surgical interventions and MCIC of knee flexion.ResultsSeventy-two studies (k = 72, n = 5174) were eligible. Meta-analyses included 140 intervention arms (k = 61, n = 4516) that reported Δ flexion with Δ pain using the visual analog scale (pain-VAS) and Δ function using the Western Ontario and McMaster Universities Osteoarthritis Index function subscale (function-WOMAC). Linear relationships between Δ pain at rest-VAS (0–100 mm) with Δ flexion were − 0.29 (− 0.44; − 0.15) (β: posterior median (CrI: credible interval)). Relationships between Δ pain during activity VAS and Δ flexion were − 0.29 (− 0.41, − 0.18), and Δ pain-general VAS and Δ flexion were − 0.33 (− 0.42, − 0.23). The relationship between Δ function-WOMAC (out of 100) and Δ flexion was − 0.15 (− 0.25, − 0.07). Increased Δ flexion was associated with decreased Δ pain-VAS and increased Δ function-WOMAC. The point estimates for MCIC of knee flexion ranged from 3.8 to 6.4°.ConclusionsThe estimated knee flexion MCIC values from this study are the first to be reported using a novel meta-analytical method. The novel meta-analytical method may be useful to estimate MCIC for other measures where anchor questions are problematic.Systematic review registrationPROSPERO CRD42022323927.

Surgical vs. Non-Surgical Management of Temporomandibular Joint Disorders: Clinical Outcomes

ABSTRACT Background: Temporomandibular joint disorders (TMDs) encompass a range of clinical conditions affecting the temporomandibular joint (TMJ) and associated structures. Management approaches for TMDs vary and include both surgical and non-surgical interventions. Materials and Methods: In this retrospective cohort study, medical records of 150 patients diagnosed with TMDs were reviewed. Patients were categorized into two groups: surgical intervention and non-surgical intervention. The surgical group underwent various surgical procedures, including arthroscopy, arthroplasty, and joint replacement, while the non-surgical group received conservative treatments such as physical therapy, pharmacotherapy, and occlusal splints. Pain levels, TMJ function, quality of life (QoL), and patient satisfaction were assessed at baseline and post-treatment (6 months and 1 year). Results: At the 6-month follow-up, both groups experienced a significant reduction in pain scores (surgical group: 6.3 ± 1.2 to 2.4 ± 0.9, non-surgical group: 6.1 ± 1.1 to 3.2 ± 1.0). TMJ function improved in both groups (surgical group: 2.5 ± 0.8 to 4.8 ± 0.6, non-surgical group: 2.6 ± 0.7 to 4.2 ± 0.9). QoL scores increased (surgical group: 35.2 ± 4.6 to 50.3 ± 5.1, non-surgical group: 35.5 ± 4.2 to 45.7 ± 4.8), and patient satisfaction rates were high (surgical group: 92%, non-surgical group: 87%) at the 1-year follow-up. Conclusion: Both surgical and non-surgical management approaches demonstrated significant improvements in pain relief, TMJ function, QoL, and patient satisfaction for individuals with TMDs.

Molecular Imaging and Therapy of Differentiated Thyroid Carcinoma in Adults.

Differentiated thyroid carcinoma (DTC) has been increasing in incidence in the United States over the last several decades, although mortality rates have remained low. Radioactive iodine therapy (RAI-T) has been a mainstay of treatment for DTC since the 1940s. Imaging of DTC before and after RAI-T primarily focuses on molecular imaging of the sodium iodide symporter. The expanding understanding of the molecular profile of DTC has increased available treatment options. Incorporation of risk stratification to treatment approaches has led to deintensification of both surgical and nonsurgical treatments, leading to decreased morbidity without compromising disease control.

Ingrown Toenails: A Survey Among Dermatologists on Current Treatments.

To date, there is no formal consensus on how to treat ingrown toenails. Despite the risk of causing irreparable damage to the nail, highly invasive procedures are still common. Less-invasive, matrix-directed techniques with shorter downtime and high cure rates exist, but, perhaps because of a lack of awareness, appear not to have been universally adopted. The authors' study sought to generate data on common practices in the treatment of ingrown toenails. The authors developed and conducted an online survey to ask dermatologists/dermatosurgeons how they would proceed in 9 different cases of ingrown toenails based on photographs. The authors received 154 replies. Nonsurgical interventions, including advice on nail care/foot baths/ointments/wraps/padding, were always the most frequently chosen option. Removal of the lateral nail plate followed by chemical partial matricectomy (phenolization) was the most or second-most frequently chosen surgical intervention. The answers were highly heterogeneous, and there was no unanimity based on morphology alone. Except for a preference for nonsurgical interventions, the authors could not identify any clear treatment standards. The heterogeneity of treatment approaches suggests the need for a guideline.

Anal fissures: An update on treatment options.

Anal fissure (AF) is the second most common anorectal complaint in healthcare settings. The presentation might be acute or chronic, characterised by severe pain with defaecation that persists for one to two hours. Non-surgical and surgical interventions are available based on the severity and persistence of the fissure. The aim of this article is to review the pathophysiology, clinical presentation andmanagement of AF under current guidelines. The aetiology of AF is unclear, although it is commonly associated with local trauma or associated chronic conditions. Acute AF is first treated with conservative therapy, including dietary fibre and sitz baths. Addition of topical nitrates, topical calcium channel blockers or botulinum toxin injection is indicated with failure of conservative treatment or at medical discretion. Surgical options are considered if AF persists despite treatment. Most present as hypertonic, but special consideration is needed for hypotonic or secondary presentations.

Cervical Kyphosis

Abstract Kyphosis of the cervical spine can have many causes. The most common causes include degeneration of the cervical spine, infection, trauma, inflammatory diseases, tumors, and iatrogenic causes. Cervical kyphosis can be associated with myelopathy and radiculopathy, so it is important to look for signs and symptoms of spinal cord and nerve root compression as well. As the kyphosis worsens, patients can experience problems with horizontal gaze, swallowing, and even breathing. The first line of treatment for cervical kyphosis is rest and lifestyle modifications. Cervical kyphosis can cause muscular strain best treated with rest and avoidance of re-injuring the muscles and tendons. Nonsurgical treatments for cervical kyphosis also includes physical therapy and pain management procedures, and is attempted if there are no findings of sensory loss, motor weakness, bowel or bladder dysfunction, or spinal cord impingement signs. Many factors play a role in the decision-making process for surgical intervention, which include level of pain, degree of physical impairment, and the amount of cervical kyphosis present. The optimal surgical approach is not always clear but can include an anterior, posterior, or combined anterior and posterior approach.

Speech-Language Pathologist's Pattern of Practice in the Rehabilitation of Head and Neck Cancer patients across Hospitals in India.

India has a significant burden of Head and Neck cancer (HNC) patients. Patients afflicted with HNC often encounter difficulties in speech, voice, and swallowing, either due to the disease itself or the treatment they receive. The rehabilitation of HNC patients is crucial, and Speech and Language Pathologists (SLPs) have a significant role in it. The current study aimed to understand the practices followed by SLPs in India while rehabilitating HNC patients. A questionnaire was developed and validated by five Speech-language pathologists, before circulation as an E-survey. The target participants were SLPs working in hospitals across India. The final online version of the questionnaire remained open for eight weeks. A total of 75 Hospital-based SLPs working in India participated in the survey. The responses depict notable trends and differences in the assessment and management approaches. HNC patients who had undergone surgery were more likely to be referred for rehabilitation than those who received non-surgical treatments. Only 36% of the SLPs reported getting pre-operative referrals for HNC patients. The time point for initial assessment and intervention, as well as the protocols used, varied across different hospitals. About 50% of participants had instrumental swallow evaluation facilities in their hospitals, and the majority of hospitals only used instrumental swallow evaluation for 1-3 assessments per week. Variability exists in several aspects of SLP practice for HNC patients offered across Hospitals in India. All HNC patients do not get access to speech-language pathology services. Developing standardized protocols towards early evaluation, intervention and enhancing compliance could improve SLP-led rehabilitation of HNC patients in India.

Cochrane Corner

This edition of the Cochrane Corner looks at the three reviews that were published in the second half of 2023: surgical versus non-surgical interventions for displaced intra-articular calcaneal fractures; cryotherapy following total knee arthroplasty; and physical activity and education about physical activity for chronic musculoskeletal pain in children and adolescents.

The efficacy and safety of non-surgical treatment of diabetic foot wound infections and ulcers: A systemic review and meta-analysis.

This meta-analysis evaluates the efficacy and safety of non-surgical treatments for diabetic foot ulcers and infections. After a rigorous literature review, seven studies were selected for detailed analysis. The findings demonstrate that non-surgical treatments significantly reduce wound infection rates (standardized mean difference [SMD] = -15.15, 95% confidence interval [CI]: [-19.05, -11.25], p < 0.01) compared to surgical methods. Ulcer healing rates were found to be comparable between non-surgical and surgical approaches (SMD = 0.07, 95% CI: [-0.38, 0.51], p = 0.15). Importantly, the rate of amputations within 6 months post-treatment was significantly lower in the non-surgical group (risk ratio [RR] = 0.19, 95% CI: [0.09, 0.41], p < 0.01). Additionally, a lower mortality rate was observed in patients treated non-surgically (RR = 0.28, 95% CI: [0.13, 0.59], p < 0.01). These results affirm the effectiveness and safety of non-surgical interventions in managing diabetic foot ulcers, suggesting that they should be considered a viable option in diabetic foot care.